Long Term Treatment of Obsessive-Compulsive Disorder

Abstract

The efficacy of clomipramine and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) in treating obsessive-compulsive disorder (OCD) is now established. However, few studies are available on long term treatment strategies in patients with OCD. In this article, recent literature on drug discontinuation and maintenance treatment of OCD is reviewed and discussed.

All studies which have evaluated recurrence rates after drug discontinuation have found that up to 80% of patients who respond to SSRIs relapse if the medication is withdrawn.

The studies that have been performed on long term treatment of OCD with both clomipramine and SSRIs show that patients who continue medication maintain and slightly increase the level of improvement achieved in short term trials. Several authors suggest that, in maintenance treatment, drug dosages can be reduced to between 40 and 60% of those used in acute episodes without a significant difference in symptom improvement.

Preliminary data concerning drug tolerability in patients receiving long term treatment for OCD indicate that SSRIs are well tolerated, and that the rate of adverse effects tends to decrease compared with short term treatment. Several recent reports suggest that patients who have taken SSRIs for at least 2 months are at risk of developing withdrawal symptoms when treatment is discontinued. However, no data are available concerning the relationship between the duration of OCD treatment and the onset of withdrawal symptoms.